Unexplained Physical Symptoms vs Somatoform Disorders

Physical symptoms appear and disappear on a regular basis in normal people. Less than 3% of these symptoms result in a visit to a physician (Banks et al., 1975), but more than half the visits to primary care physicians are for symptoms. Even symptoms severe enough to trigger a visit are usually self-limited; about three-quarters improve or disappear in 2 weeks, and over half of those remaining have improved or disappeared at 3 months (Kroenke and Jackson, 1998). Most patients do not remember having a symptom that they reported 1 year earlier (Simon and Guerje, 1999). From this cohort of symptomatic patients, a substantial number have symptoms sufficiently persistent, severe, or numerous to justify a diagnostic workup, which usually reveals a medical problem that the family physician manages in the usual

Box 46-1 Personality Disorder Clusters*

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